Bezem Janine, Kocken Paul L, Kamphuis Mascha, Theunissen Meinou H C, Buitendijk Simone E, Numans Mattijs E
Preventive Child Health Care Department, Gelderland-Midden Municipal Health Service, Arnhem, The Netherlands.
Department of Child Health, TNO, Leiden, The Netherlands.
BMJ Open. 2017 Oct 30;7(10):e016423. doi: 10.1136/bmjopen-2017-016423.
A novel triage approach to routine assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carried out pre-assessments of all children and sent the children with suspected health problems to follow-up assessments conducted by a physician or nurse. This two-step approach differed from the usual approach, in which physicians or nurses assessed all children. This study was aimed to examine the impact of triage and task shifting on care for children at risk identified by PCH or parents and schools.
An observational prospective cohort design was used, with an analysis of the basic registration data from the preventive health assessments for 1897 children aged 5 to 6, and 10 to 11, years from a sample of 41 schools stratified by socioeconomic status, region of PCH service and urbanisation.
A comparison was made between two PCH services in the Netherlands that used the triage approach and two PCH services that provided the usual approach.
The primary outcome measures were the referral rates to either additional PCH assessments or external services. The secondary outcome measures were the rates of PCH assessments requested by, for example, parents and schools.
Overall, a higher referral rate to additional PCH assessments was found for the triage approach than for the usual approach (OR 1.3, 95% CI 1.0 to 1.6), mainly in the age group of 5 to 6 years (OR 1.9, 95% CI 1.3 to 2.7). We found a lower rate of referral to external services in the triage approach (OR 0.4, 95% CI 0.3 to 0.7) and a higher referral rate to PCH assessments on request (OR=4.6, 95% CI 3.0 to 7.0).
The triage approach provides extra opportunities to deliver PCH assessments and PCH assessments on request for children at risk. Further research is needed into the cost benefits of the triage approach.
引入一种针对常规评估的新型分诊方法，以提高儿童预防性保健（PCH）的效率：PCH助理对所有儿童进行预评估，并将疑似有健康问题的儿童送去由医生或护士进行后续评估。这种两步法不同于常规方法，常规方法是由医生或护士对所有儿童进行评估。本研究旨在探讨分诊和任务转移对PCH或家长及学校识别出的高危儿童护理的影响。
采用观察性前瞻性队列设计，分析了来自41所学校的1897名5至6岁以及10至11岁儿童预防性健康评估的基本登记数据，这些学校按社会经济地位、PCH服务区域和城市化程度进行了分层。
对荷兰采用分诊方法的两家PCH服务机构与提供常规方法的两家PCH服务机构进行了比较。
主要结局指标是转介至额外PCH评估或外部服务的比率。次要结局指标是例如家长和学校要求进行PCH评估的比率。
总体而言，分诊方法转介至额外PCH评估的比率高于常规方法（比值比1.3，95%置信区间1.0至1.6），主要在5至6岁年龄组（比值比1.9，95%置信区间1.3至2.7）。我们发现分诊方法中转介至外部服务的比率较低（比值比0.4，95%置信区间0.3至0.7），而应要求转介至PCH评估的比率较高（比值比 = 4.6，95%置信区间3.0至7.0）。
分诊方法为高危儿童提供了额外的PCH评估机会以及应要求进行PCH评估的机会。需要进一步研究分诊方法的成本效益。
